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Annals of Oncology Advance Access published online on June 9, 2006
Annals of Oncology, doi:10.1093/annonc/mdl127
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© 2006 European Society for Medical Oncology
Received April 24, 2006
Accepted April 26, 2006

original article

Maintenance rituximab following induction chemoimmunotherapy may prolong progression-free survival in mantle cell lymphoma: a pilot study from the Wisconsin Oncology Network

B. S. Kahl 1 *, W. L. Longo 1, J. C. Eickhoff 2, J. Zehnder 3, C. Jones 3, J. Blank 4, T. McFarland 5, W. Bottner 6, H. Rezazedeh 7, J. Werndli 1, and H. H. Bailey 1

1 Department of Medicine, University of Wisconsin, Madison, WI, USA
2 Department of Statistics and Bioinformatics, University of Wisconsin, Madison, WI, USA
3 Department of Pathology, Stanford University, Palo Alto, CA, USA
4 Green Bay Oncology, Green Bay, WI, USA
5 UW Health Hematology/Oncology, Madison, WI, USA
6 Gundersen Lutheran Medical Center, LaCrosse, WI, USA
7 Aspirus Cancer Center, Wausau, WI, USA

* To whom correspondence should be addressed.
B. S. Kahl, E-mail: bsk{at}medicine.wisc.edu


  Abstract

Background: There is no standard first line treatment for mantle cell lymphoma.

Patients and methods: This was a multicenter phase II pilot study of rituximab and modified hyper-fractionated cyclophosphamide, vincristine doxorubicin, dexamethasone (modified R-hyperCVAD) administered every 28 days for four to six cycles followed by rituximab maintenance therapy consisting of four weekly doses every 6 months for 2 years. Unlike traditional hyperCVAD regimens, no methotrexate or cytarabine was administered.

Results: Of 22 patients, the overall response rate was 77% and the complete response rate was 64%. With a median follow-up time of 37 months in surviving patients, the median PFS was 37 months and the median OS was not reached. The achievement of a molecular remission did not correlate with improved outcome. The major toxicity was expected myelosuppression. Two patients died during induction treatment. There were no major adverse effects during maintenance therapy.

Conclusion: In a multicenter trial, modified R-hyperCVAD was tolerable and effective induction therapy for untreated MCL. Maintenance rituximab appeared to prolong PFS without increasing toxicity.

Keywords: mantle cell lymphoma; chemotherapy; biologic therapy.
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